Provider Demographics
NPI:1235552183
Name:VOORHEES, JEREMY
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:VOORHEES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3669 SOUTHWESTERN BLVD.
Mailing Address - Street 2:MERCY AMBULATORY CARE CENTER (ATHLETICARE)
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-828-2455
Mailing Address - Fax:716-828-3561
Practice Address - Street 1:3669 SOUTHWESTERN BLVD.
Practice Address - Street 2:MERCY AMBULATORY CARE CENTER (ATHLETICARE)
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-828-2455
Practice Address - Fax:716-828-3561
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist